and we see the exit sign (and we see it all)
by darknessinastateofmind
Summary: "He always knew, one day, that he would get what he deserved. He knew, and he knows." In which Alex Karev is diagnosed with cancer. And in which everyone and everything falls apart before it all falls together.
1. Chapter 1

Author: darknessinastateofmind

Summary: "He always knew, one day, that he would get what he deserved. He knew, and he knows." In which Alex Karev is diagnosed with cancer. In which we see everyone and everything fall apart before it all falls together.

Warnings: Cancer

Pairings: Eventual Alex/Izzie

Disclaimer: I do not own Grey's Anatomy nor any of the characters mentioned. All rights belong to the owner.

Author's Note: I'm back again with more Alex angst, but this will have quite a large amount of hurt/comfort and medical jargon too! And it's a multichapter. Let's see if I'll be able to keep it up. Title comes partially from "Neverending Fountain", by S. Carey. Please review and favorite! (But reviews, especially, will make me update faster...) I hope you enjoy.

* * *

 _No one will comfort me_

 _Will know me or what's going on inside_

 _A vacant hole will remain that way for life_

 _To remind me where the both of you once lied_

 _-Friends Make Garbage (Good Friends Take It Out), by Low Roar_

* * *

 _CHAPTER: l._

Alex Karev is a dick. He is Evil Spawn, douchebag extraordinaire, dirty Uncle Sal. So, honestly, why the hell is he so surprised when he gets cancer? Karma's a bitch, and all the shitty things he's done in his life went around to bite him in the ass.

He always knew, one day, that he would get what he deserved. He knew, and he knows.

Except.

Except, he _is_ surprised. He's horrified. He's terrified and scared and so utterly shocked that, when the tests come back, he can't do anything much more than just sit there, stare at his oncologist, and try not to panic.

"Mr. Karev," Dr. Young says, his voice calm and placid. Alex realizes with a jolt that it's the same exact tone _he_ adopts when delivering bad news to a patient.

"Doctor," Alex chokes out. "It's Dr. Karev."

"Right, my apologizes. Dr. Karev, first of all, the results from your blood count were… discouraging. Your white blood cell count is very high - too high. After the biopsy, physical examination, and the spinal tap…" He takes off his glasses and clears his throat. "I'm sorry, Dr. Karev. You have precursor b-cell acute lymphocytic leukemia."

And there it is: The end of it all.

* * *

He drives home in a blank haze. In complete honesty, Alex isn't entirely sure what just happened. He just focuses on pressing the gas pedal with his foot and hitting the brake when he should, he just focuses on the road in front of him. Any time is brain starts to stray, begins wrapping itself around the enormity of the situation, any time he starts to panic, he tells himself to _stop_.

Stop.

He'll deal with this when he gets home, when he reaches Meredith's house and he can sit down alone and fully break down and not get into a car accident.

He'll deal with his life later.

* * *

Later comes, and he still doesn't know what to do. Meredith and Izzie will be back from the hospital in a few hours. He had left early to get the results, and he had expected to go back, but now he can't even imagine going into that place and act normal.

Alex tries to get some sleep, and he's successful for some time, but he still can't get the suffocating lump of ever-present fear out of his chest.

He stumbles into the bathroom and collapses on the floor, leaning against the sink. He holds the test results in one hand while the other rests on the cool tiles.

Alex sits there for a good half an hour, barely moving. Just thinking and trying hard not to panic because he's losing his fucking mind and he's terrified and tired and he has the worst headache and he doesn't know what the hell he's supposed to do and, oh God, he'll have to tell Izzie and Meredith and Bailey and the Chief and fuck he's screwed, he's starting chemo in a few days so he _needs_ to tell someone so they can drive him, fuck fuck fuck fuck fu-

"Alex?"

He jolts his head up in surprise when the door opens and Izzie's blonde head pops in. He instinctively curls the papers behind his back, even though he _knows_ he's going to have to tell her eventually. "Hey, Izzie," Alex says, and he's surprised at how normal his voice sounds.

She stares at him with an unimpressed expression and crosses her arms. "Alex. Where the hell did you go? Dr. Bailey's gonna hit the roof tomorrow. And Cristina already said she'll kill you 'cause you made her miss scrubbing in on an open heart. Did you hear me? Cristina missed an _open heart_. Alex, are you even listening? Because Cristina will kick your ass tomorrow, I'm not even joking. And Meredith is pissed, too. She was in the Pit practically all day doing sutures 'cause of you. And George..."

Alex closes his eyes and leans back, resting his head on the side of the sink. He only half-listens to her incessant chatter, because all he can think are three words: _I have cancer._

He knows he should tell her. He should cut her off with a firm _Izzie_ , then proceed to say _I have cancer_ in the most dramatic and heart-wrenching way possible, like what happens in those cheesy soap operas Izzie and Meredith are always watching.

But it's not a cheesy soap opera. It's Alex's crappy life, and right now, his butt is aching. And so are his bones and his heart too, a little.

"Hey, are you okay? What did your doctor say about your fevers?" Izzie's worried face swims in his vision, and he blinks to clear the yellow spots from his field of view.

 _And this is where you tell her. Just say it:_ I have cancer. _Just say it._

"I - I…" _Say it._ "It was nothing," he blurts out. "Nothing at all, just the flu or something, okay? Can you just go, please? Your voice is really annoying me, and I have a headache."

She reels back. "I was just trying to warn you. Sorry for being nice." She shoots him an icy glare and leaves the bathroom with a flourish, slamming the door closed behind her.

And there he goes again, doing what he does best, the only thing he knows: Pushing people away.

* * *

Izzie was right. Work is a hell hole the next day, with Cristina sending him death glares every time he turns a corner that have him legitimately fearing for his life, Meredith ignoring him, O'Malley ignoring him (why, he has no idea), Bailey's endless lectures and saddling him with the Pit and prostate exams, and the pain.

God, he _hurts_. He has no idea why it hurts so much. Well, he does have an idea, but why so suddenly, Alex doesn't know. Maybe it's because he's suddenly conscious of the life-threatening things constantly multiplying and killing him underneath his skin. Maybe he's dying already. Whatever it is, it's painful. Alex's bones hurt from the deepest orifice. They burn with every movement, with every breath he takes and every heartbeat. And he's tired. In retrospect, Alex supposes he's been tired for a few months now, but today, he's exhausted.

All he really wants is to lie down and sleep for one hundred years.

Which he tries to do, during lunchtime. Alex drags his exhausted body to the on-call room and collapses on a mattress, massaging his aching limbs and his pounding head. It seems like only minutes have passed when Meredith jerks him awake with a harsh poke at his exposed neck. "Alex. Bailey's looking for you." A pause, then: "Alex?"

He groans into the pillow, then turns around and blinks the sleep from his eyes. "Wha-"

Alex is cut off by Meredith's expression. She's staring at him with something akin to horror.

"What?" he asks, standing up and smoothing out his rumpled scrubs.

Meredith's hands dart out and land underneath his jaw. Damn. His swollen lymph nodes. "Get off of me," Alex snarls, ducking away from her hands.

"Alex, they're swollen," she says in a pleading tone. "You have to know what that could mean."

"I have a medical degree too, you know. I know what it could mean. I just have a cold or something, I already went to my doctor yesterday. So lay off, _Mom_."

Meredith shakes her head, but she stands her ground. "Why do you always do this? Push everyone away when we're just trying to help."

"I don't push anyone away, _Mom_."

"Alex."

" _Mom_." And he shoves his pager in his pocket, throws open the door, and then steps into the light.

* * *

Bailey puts him on call that night, and it's the first time he's happy to be staying the night at the hospital; he can't face Izzie and Meredith.

It's actually pretty boring. Nothing eventful happens, which gives him a lot of time to think. Like, what the hell he's supposed to do if every time he tries telling someone about his cancer, his mouth does the opposite. Or, maybe the whole entire acute lymphocytic leukemia thing in general.

Alex thinks for six hours, but he doesn't come up with an answer.

He finds himself in the oncology ward around one o'clock, during a calm period with his patients, when they're all sleeping and stable.

Alex tries his best to be subtle, but he's immediately spotted by Dr. Swener. Luckily, he's able to make up some lie about a patient he's supposed to be checking on or something, and she lets him go by without much comment.

The chemotherapy room is closed, but he peeks through the window at the door. There's nothing particularly interesting - just a couple recliners and IV poles. The darkness makes it hard to see. Alex swallows thickly around the large lump that has suddenly developed in the back of his throat, and he backs away from the closed door.

He rubs a shaky hand over his face and slides down against the wall until his butt touches the linoleum.

What is he supposed to _do_?

He has cancer, he is sick, and he might be dying.

Alex is a doctor, and while he doesn't specialize in oncology, he knows what b-cell common acute lymphocytic leukemia is. And he knows the statistics, he knows the survival rate.

And his odds aren't terrible - they could be much worse. But, just yesterday morning, Alex thought that his chance of surviving the next five years was one-hundred percent, and now, it's down to forty?

It's crazy how quickly a life can fall apart.

* * *

His pager beeps multiple times, but he makes no move to respond to them. They're all from Bailey, anyway, not his patients. Alex knows he'll get hell for it after, maybe even serious trouble from the Chief, but at this point, who gives a fuck? He certainly doesn't.

He's far too tired and aching to do anything more than sit with his elbows on his knees and the heels of his hands pushed into his eye sockets, waiting. For what, he doesn't know. But he waits anyways, because he doesn't know what else to do.

"I thought I might find you here."

Alex raises his head slowly from where it has been for the past hour, dreading the inevitable. He knows that it's Bailey; her commanding "Nazi" voice is hard to mistake.

When he finally lifts his head enough to make eye-contact, Alex notices something strange. She doesn't look angry at all, even though he just spent the past hour ignoring all of her pages. Her eyes are heavy and thick with emotion, and they seem red and puffy, like she was just crying.

She heaves a sigh and sits down next to him. "I found these in the locker room." She holds out a thin stack of papers to him.

Alex cautiously takes them from her. He knows what they are, deep down, and he's already read them more times than he can count, but when he reads the words "acute lymphocytic leukemia" and "vincristine, dexamethasone, doxorubicin (VAD) to be administered in three phases over the course of two years" and "intrathecal chemo", he balks. And then he swallows. And then he starts to cry.

He tries hard to quell the overwhelming urge, gulps around the thick lump in his throat. It's too late, though, and the tears come faster than he can control.

Alex can't recall the last time he cried. He truly cannot, because he doesn't. Yet, here he is, crying.

At first, the tears well up in his eyes and slowly crawl down his cheeks. Soon, his shoulders are shaking and his chest feels heavy and it's sort of hard to breath the way he's sobbing so hard.

 _I_ _can't do this_.

Sometime in the beginning of his cry-fest, Bailey had wrapped her short arms around him and placed his head on her shoulder. He had tried to pull away, but she had held fast, saying nothing, because everything was already said. Eventually, he lets her hold him.

He doesn't know when it got to this. Tude and arrogant Alex Karev, blubbering into Bailey's shoulder like some pathetic little kid who had just lost everything.

* * *

He's terrified beyond reason.

* * *

He stops crying after a while.

He's still empty.

Empty, bare, desolate.

* * *

"Who's your oncologist?"

"Dr. Young. Mercy West."

Bailey shifts and looks him in the eye. Her's are filled with sympathy and remorse and something else that he can't really place. He hates it.

"We could get Dr. Swender on your case, you know. She's the best around here." As an afterthought, she adds with a half smirk, "Certainly better than anyone at Mercy West."

Alex huffs out a breathless laugh. "Yeah, probably." A few moments of silence, then: "I can't, though. Fuck - sorry. You know why. I can't." _I can't be weak, I can't rely on anyone, I have to be strong._

"No, Karev, I don't. You deserve the best care there is, and Dr. Swender can give you that. So, why don't you put away that thick-headed pride of yours and _get better_." She turns and stares him down. Her eyes are no longer a jumbled mix of sad emotions - they're hard and determined.

And he wants to believe her. And, maybe a few years ago, he would have. Maybe, if this had happened before his dad started regularly beating up everyone in his family, he would have. But it's been years, and it's been that many years since he's believed in the joke that is called hope.

"Dr. Bailey, with all due respect, you're wrong. You saw those papers, you read them. I have over seventy thousand white blood cells. And I'll have to go through utter hell for the next two years, and for what? A forty percent chance of surviving the next five years? That's shit, Dr. Bailey. You know it is. I'm sorry, but it's shit, and it's my life, and that's just the way it is."

"Yes. That is the way it is, that is the way your cancer is, but that doesn't mean _you_ have to be this way. You're sick, not dying. This isn't a death sentence. You _will_ get better, Karev. Get over your pity party."

Alex just shakes his head. He's far too drained to fight.

"Now, get up and go home. Get some rest. You're starting chemo on Wednesday, right? Don't come to work tomorrow. I'll take care of it."

He nods and slowly stands. The pain in his bones, deeply rooted and sharp, is so blinding he's unable to suppress the breath of pain he emits because _ow, that hurts like a bitch._

Her eyes flash with alertness and she stands too, opening her mouth to say something.

Alex puts a hand out, a silent _don't_ and she backs off in understanding. He's already shed half of his ego sobbing into her shirt, so he can't afford to lose any more. "And, if you mention the little incident that just happened to _anyone_ …"

"Are _you_ threatening _me_ , Karev?" she asks, but smiles and nods anyway. "Go home. And don't think you're off the hook for ignoring all of my pages, too."

"Okay, okay." A pause, then, "Thank you."

She nods.

Alex grips the papers in one hand, but then, as an afterthought he says, "Please don't tell anyone. Please, I'll tell them myself."

Bailey sighs. "Alex, I can't do that. You're seriously ill, and you're going to be much sicker very soon. I am going to have to tell the Chief, and I will also bring your case to Dr. Swender. As your chief resident - your boss - your wellbeing is partially my responsibility, and from my perspective, Dr. Swender will give you the best care. So, no. I'm sorry."

He squeezes his eyes shut and releases a long breath. _It's okay. It's okay, Alex, get your shit together._ "Okay. You can tell the Chief. But, damnit, please, don't tell anyone else. Please, don't go to Dr. Swender. Don't go. Don't tell anyone. I'll do it. Please." He hates that he's been reduced to this - a scared, weak kid who cries and begs and breaks.

Dr. Bailey takes a step and tries placing a hand on his trembling shoulder. He jerks back, retreats into his shell. She nods, once. "Go home, Karev."

Alex shudders, slowly, in slow motion, then turns without a nod and slowly makes his way across the hall.

* * *

He drips with shame.

* * *

 _TBC_


	2. Chapter 2

Title: and we see the exit sign (and we see it all)

Author: darknessinastateofmind

Summary: "He always knew, one day, that he would get what he deserved. He knew, and he knows." In which Alex Karev is diagnosed with cancer. In which everyone and everything falls apart before it all falls together.

Warnings: Cancer

Pairings: Eventual Alex/Izzie

Disclaimer: I do not own Grey's Anatomy nor any of the characters mentioned. All rights belong to the owner.

Author's Note: Hello, it's me again! My apologies for the cheesy _Catcher in the Rye_ references and comparisons. I couldn't resist. And, I'm sorry that not all the characters are in it. I swear that others will make an appearance later on, as will actual action… Please review/comment, and enjoy.

To the reviewer that questioned the medical accuracies: I did do a lot of research, but you are correct, the disease I gave Alex is not a thing! I must have been blanking out when I was writing it, my apologizes. I have changed it since then.I disagree, though, with your second point. Though ALL is most common in children, four out of ten cases are found in adults, and four out of five deaths from ALL occur in adults. It may be uncommon, but it is not rare or impossible.

* * *

 _Every day there's a boy in the mirror asking me..._

 _What are you doing here?_

 _Finding all my previous motives_

 _growing increasingly unclear._

 _-Homesick, by Kings of Convenience_

* * *

 _CHAPTER: e._

"Okay, Alex, I'm just going to insert this needle into your Hickman line," the nurse says. "Could you lift up your shirt for me?"

He obliges, yanking the neck his t-shirt down. Under normal circumstances, he would have made some inappropriate remark about her request, but the circumstances are far from normal, and he doesn't feel at all like joking. Or just talking, in general.

She does what she has to do gently and carefully, then rubs her hand across his shoulder in a way that she probably thinks is comforting, but actually just makes him feel awkward. "If it starts to feel particularly cold or if there's a really bad burning sensation, make sure you inform someone, okay?" she says, and smiles. He lifts the corners of his lips, but he can't quite manage to spread them wide enough to a resemblance a smile.

The nurse leaves, after adjusting the machine and bags of drugs hanging on an IV pole above his head. "You'll be finished in a few hours or so. Call me if you need anything." Alex nods, and she leaves.

Alex sits stock-still for a good minute, staring at the bag which reads CAUTION in bright, screaming letters.

He shifts in the recliner, trying to get comfortable. Alex heaves out a deep sigh and leans back, closes his eyes. Even though Bailey had told him to not go to work today, he wants to. He needs to.

He still hasn't told anyone besides Bailey, and even that wasn't voluntarily. He isn't sure if she's told the Chief, and he's too afraid to ask. Probably. He hasn't been to work in three days, and Izzie and Meredith haven't brought anything up.

The day before, he had the Hickman line inserted, which was hell. He had to ask Bailey to pick him up from the hospital after the mini-operation - the hospital didn't let him drive by himself or take public transportation. To Alex's horror, she thought it was necessary to _show up at Meredith's house and stay with him during the entire thing_. The worst thing about it was that the local anesthesia administered made him forget everything he said when it was happening.

Bailey was thoroughly amused on the drive back home, so he must have said some crazy shit.

Alex yawns and grabs his book from his backpack. He's reading _The Catcher in the Rye_. Izzie told him to read it a while ago. For some reason, she was weirdly outraged when he told her he had never read it. "Who hasn't read _The Catcher in the Rye_? It's, like, an English requirement for the entire nation or something," she chirped, her wide eyes widened .

"Izzie. I grew up in Iowa," he had replied with a smirk.

"Fair enough."

Anyway, she had been bugging him to read it for a long time now, so he had picked it up at the library a few days ago. It actually isn't that bad. It's funny, and he finds himself relating to Holden in more ways than he should. There's definitely a depressing undertone that Alex is missing, but he doesn't care. He was never much of an English student, and all he wants to do is enjoy the stupid book without analyzing it to death.

Alex checks his phone for the time again. It's almost four. Which means he has another hour and a half of drugs being pumped through his veins. Great.

It's irrational (and not because he'll be really sick after, but because Bailey would kill him) but he wants to go to work. He had spoken to his oncologist about it, who warily said that he could _probably_ go to work, long as a schedule was worked out between his treatments. But, when he asked if he could go to work right after a session, his oncologist had laughed out loud before he'd realized Alex was dead-serious.

He closes his book and slips it back into his bag. His head is pulsing, and he an ache had begun to build in that sensitive spot just behind his eyes a few minutes ago. He shuts his eyes, filled with an overwhelming sense of tiredness.

Soon, he is lulled to sleep by the calming sound of dripping poison seeping its way into his body.

* * *

"Alex. Alex, wake up."

 _God, shut up! Let me sleep!_

"Karev."

Alex grimaces and cracks open his eyes. It's… Bailey? _What the fuck?_ He stands up without thought, and immediately, he's lightheaded from the sudden vertigo that hits him. "Wha-what are you doing here?"

"Whoa, Karev, careful there," she grabs his arm to steady him. Her brow is twisted with concern. "You're lucky they already disconnected your port."

He repeats the question, ignoring her words. "What are you doing here?"

"I'm here to make sure you don't crash your car into a tree on your way home. Didn't I already tell you I was going to come pick you up?" Her tone is sharp and impatient, but Alex isn't able to miss the worry flash in her eyes.

"No. I never agreed to it," he says, his voice still thick with sleep. He sounds weird, kid-like and scared. Irrational panic suddenly bubbles in his stomach, mixing with the nausea that's already threatening to upchuck his meager breakfast all over Bailey's shiny sneakers. "I don't need a babysitter," he grumbles. And it's true, he doesn't. He can easily drive himself home, as soon as the room stops spinning...

"No, you don't," she agrees, "but you do need someone to take you to and from chemo sessions. Because you're too thick-headed to get treatment at Seattle Grace and tell anyone, it'll have to be me." Her cocked eyebrow and jutted out hip scream at him to _shut_ _up_ , and he knows that, if he wants to survive, he should. But he doesn't.

Why?

Because, he is Alex Karev. He is Evil Spawn. And his job is to make the lives of others' miserable, cancer be damned. "I don't need anyone to bring me anywhere, okay? I'm fine. Really, I am, so can you just go, please?" He takes an unsteady step forward, away from her, and almost gasps at the weird, sinking feeling in his limbs. Without warning, his legs give out from underneath him, and he's heading straight for the ground. Bailey's arms suddenly shoot out and catch him by his armpits, but it's too late.

She lowers him to the ground, and he would open his eyes to see what's going on, but they're dry cement, refusing to open to more than half-slits.

"I think I'm just gonna rest here…" he mumbles, sagging against the ground.

"Okay, Alex. Okay."

* * *

When he comes to, Alex is aware of only three things. First: He has a headache the size of Russia. Second: He's so fucking screwed, for reasons he doesn't exactly know. Third: He's at Mere's house, which means that Bailey must have told them, to have gotten in the house in the first place…

Now he knows the answer to number two: Bailey had to have told Mere and Izzie, which means a bucket load of shit for Alex to deal with.

He sits up, slowly and carefully, but even the slightest of movements twists his already messed-up stomach into knots. "God dammit."

He's got a headache the size of Russia, everyone probably already knows he has cancer, he's exhausted (even though he just spent, what, two hours sleeping?), and how about _oh, right, YOU HAVE CANCER, DUMBASS._

"Alex? Are you awake up there?" Definitely Izzie. Her footsteps reach his bedroom door.

"Is he awake?" Meredith. Her whispering skills are terrible.

"I don't know, I thought heard him say something…"

"Alex?" A gentle knock. "I'm coming in, okay?"

Alex pulls the covers over his head. Blocking out the girls and his whole life for half a second.

"Hey, you're awake!"

And that millisecond is up. "No, I'm not," he mumbles back.

The covers are pulled back, and Izzie's face swims into view. "God, you look _terrible_."

"Thanks."

"No, seriously, you look really, really bad," She extends her hands a to his forehead, his cheeks. "You're warm. You feel warm. Meredith, doesn't he feel warm?"

Alex rolls his eyes and pushes her hands away. "I'm fine, okay? Just leave me alone. 'm tired." He rolls over onto his side, away from the girls.

They don't leave. Meredith walks over to his side of the bed and sits down on the ground, with her back up against the wall. Izzie takes a seat on his bed. "So," Mere starts, carefully. She's looking at her hands, and her tone is much less subdued than Izzie's. How much does she know? "Is there anything you have to tell us?"

"What's there to tell? I'm guessing Bailey told you everything already."

"She didn't. She just said something about how you'd tell us yourself, and that you were sick or something," Izzie replies. "It's not anything serious, right?"

Alex clenches his jaw and shuts his eyes, first against the wave of nausea that crashes into him like a freight chain, second to block, even for just a second, the total shit-fest that's going to go down in a few minutes. He wishes that Bailey had already told them, so that he doesn't have to do it himself.

"It's cancer, isn't it."

His eyes fly open, and he stares at Meredith. "Wha-"

"Right? I'm not wrong?" Her gaze is unflinching, but her blue eyes are shiny with unshed tears.

Izzie grabs his hand. "What? You have cancer? Meredith, you _knew_?"

She shakes her head. "He had swollen lymph nodes the other day - I, I didn't think…" She looks down at her lap, and tears begin to fall.

"What do you mean? Alex - Alex doesn't have cancer. You don't, right? You had a cold, the flu or something. That's what you told me. Right? Alex, answer me. _Right_?" Her words come out in a frantic rush. " _Right?_ "

"Izzie-"

She tears her hand out of his hold. Her eyes are wild and darting, terrified. Alex sits up, ignoring his body's' creaking protests. "Izzie. You don't get to freak out. Please, stop freaking out, because now I sort of wanna freak out, and I'm trying really hard not to right now."

She swallows. Squeezes her eyes shut. Reigns it all in with one deep breath. "Please, Alex, tell me you're lying. Please."

"I - I can't. I'm sorry." His voice is hollow. "I wish I could. But I can't. I'm sick."

Meredith sobs and Izzie trembles and he tries his hardest not to lose his mind.

* * *

It takes forever, but eventually, all three of them calm down, and Alex reveals the details of his illness.

That is, until he throws up. He's describing his drug regime to the girls when he feels a familiar sinking of nausea, and a sour taste creep up from the back of his throat. He bolts upright, plowing through Izzie in his haste and knocking into the bedstand table ( _ow, that's gonna bruise)_. The bathroom light isn't even on when he kneels over the toilet, retching up bile and water and nothing, because that's all he ate.

He lets out a frustrated moan and leans back against the sink, the cool ceramic offering little relief to his roiling stomach, pounding head, and body-numbing exhaustion.

Izzie steps in, then, carrying a glass of water and a cloud of worry. She hands him the glass, silently, and flushes the toilet. Alex takes a slow sip, then grimaces. "Did they give you any antiemetics before you started chemo?"

"Yeah, but it must've stopped working… or something." He sets the glass down on the floor and curls up on the floor, pressing his cheek against the tiles.

"Hey, let's get you back into bed, okay?" she whispers, kneeling on the ground next to his head.

But, he's tired. Too tired to listen to her, too tired to move. "No… 'm fine here."

She sighs, but after a moment, lies down next to him. Her hand is in his hair, tracing small circles along his forehead and the back of his neck. It's soothing, her feather touches, and his eyelids begin to droop. "Sorry I didn't tell you sooner," he whispers, his words crashing together in his sleepiness.

"It's okay, Alex," she whispers back.

He falls asleep.

* * *

When he comes to, he's still on the bathroom floor, with a pillow underneath his head and a blanket around his shoulders. His headache is marginally better, though he's still tired and his stomach is still twisted in tight coils.

Alex leans over and throws up into the toilet, quietly, as to not alarm his easily perturbed housemates. When he's done, he flushes, rinses the sour taste of his mouth, and stumbles to his bed, which suddenly seems much more comforting than the bathroom floor.

He collapses, face-down, onto the bed. He's tired, more tired than he can remember ever being in his life, but he can't sleep. The wonderful mixture of overall shittiness has ensured that to be impossible.

After a while, he picks up some sounds from downstairs.

A door opens. The grinding of the coffee machine. Meredith's trying to whisper, but her words drift up the stairs and into his room, where he catches bits and pieces of their conversation. It appears that Derek is here.

" _Hey…"_

" _... is he?"_

" _Good, I think… sleeping…"_

" _... chemo?"_

" _Mercy West… yeah. Upstairs... thanks."_

He doesn't need to be a genius to figure out who they're talking about.

So, Derek knows, now. Who else did Meredith and Izzie tell? They probably already blabbed to O'Malley and Cristina... Bailey knows, and she's definitely told the Chief… Cristina might've told Hunt…

Basically everyone in the hospital, then.

Excellent.


	3. Chapter 3

Title: and we see the exit sign (and we see it all)

Author: darknessinastateofmind

Summary: "He always knew, one day, that he would get what he deserved. He knew, and he knows." In which Alex Karev is diagnosed with cancer. In which everyone and everything falls apart before it all falls together.

Warnings: Cancer, language

Pairings: Eventual Alex/Izzie

Disclaimer: I do not own Grey's Anatomy nor any of the characters mentioned. All rights belong to the owner.

Author's Note: This chapter has scenes I've been looking forward to since I came up with this story! So excited for you guys to read them :) I forgot to mention this earlier, but this is set ambiguously during their resident year (before the whole George thing) so there will be information from before and after that. The line's a little blurred, you can infer the time however you want. Also, all the medical stuff were taken from the internet, and a bit of it is guesswork. I am not an expert, so feel free to correct me on any of that stuff if you catch anything wrong. Thanks for reading, and please review/comment!

* * *

 _You've got a warm heart,_

 _you've got a beautiful brain._

 _But it's disintegrating,_

 _from all the medicine._

 _from all the medicine._

 _from all the medicine._

 _-Medicine, by Daughter_

* * *

 _CHAPTER a._

He was right.

Everyone knows, now. It sort of sucks. But, at the same time, it doesn't. Not as much as he'd expect Like, sure, it's annoying as shit when there's ten people in the house after a chemo session, and all the sympathy is stifling and gag-inducing all the time, but...

It's okay. It could be worse.

It's easier, in a way, with everyone knowing. One less thing on the three mile long list of things to worry about. Still annoying, though.

And awkward. _God_ , so fucking awkward. The Chief's short visit to the house last week was definitely the worst. He was so tired he couldn't even sit up and form coherent sentences, and all of it generally went to shit. The end result was Alex begging to go back to work, and an ER visit - he fell on his face trying to get out of the bed, got a bloody nose, and it didn't stop. His stupid interns gawked at him the entire time he was getting the nasal packing, and the whole hospital was gossiping about him after that.

After the hospital, he wasn't so sure he actually wanted to go back to work. He loved surgery and everything, but the sympathy is too much. He's still Alex Karev, asshole Alex Karev, but everyone seems to have forgotten it, now that there's cancer added into the mix. Even Mark-fucking-Sloan said "I'm sorry". He almost threw up. (Literally. He was feeling pretty nauseous.)

So, correction. Everyone knowing sucks.

* * *

It's sort of crazy how this has become his life. How treatment, side-effects, doctor's appointments, and sleep are considered a normal day. He's dreading the whole hair-falling-out stuff. He's been in chemo for almost a week now, and it's supposed to start coming out soon.

Not that hair really matters to him or anything, but it's still… weird? Innerving? Overwhelming? Utterly terrifying?

He runs a hand through his hair and examines the back of his head in the bathroom mirror, inconspicuously checking for any bald spots. There's nothing out of the ordinary.

 _Yet._

He grabs his toothbrush and sticks it in his mouth, avoiding his reflection in the mirror as well as he can. He knows what he looks like - pale, skinny, worn-down - and he doesn't want to see it again. His appearance isn't pretty, not in the least bit. It's scary. He's already lost five pounds, and his eyebrows and eyelashes are starting to thin and fall out. He looks like… like a cancer patient. And he didn't think appearance would matter to him at all, that being a shell of a former self wouldn't be such big deal. He was wrong, because side effects he can deal with. He can take antiemetics, even if they don't work half the time, and he can sleep the day away, and he can deal with pain. But this… this physical aspect of his disease is it's own thing entirely. Because, even it beats this thing, he'll always have the scars, he'll always have the memories.

Alex rinses out his mouth and leans against the sink. Before this, he'd always taken cancer patients' hair loss for granted. He'd think (and sometimes say), _it's going to grow back. Stop overreacting_. Insensitive, maybe, but he's an honest guy, and it was always annoying as hell when some cancer patient was freaking out about their _hair, of all things_ when they were dying. Some woman even refused to get treatment because she valued her goddamn hair over her life, apparently.

Now, though, with his own hair loss in the very near future… Well, he gets where they're going at. It's not like he's going to throw a fit and refuse chemo because of his hair, of course he's not going to do that. But, now, he understands why hair loss is about more than being bald. It's how terrifyingly real it all is. How final, sort of like a reality-check. This isn't some messed-up dream, this is life, and as much as he wishes it weren't, this is _his_ life.

He's having another round of treatment tomorrow. Five days a week he has them, and today being a Sunday, he's free. _Free to do what?_ he thinks bitterly. _Sleep? Talk to the sympathetic idiots who are only here to appease their conscience?_

"Alex? Are you awake? There's people here!"

* * *

 _Sympathetic idiots, it is._

It's Cristina and O'Malley. They're sitting at the kitchen counter and whispering with Izzie and Meredith. About him, obviously, because they all shut up the second he trudges in the room.

"Sleeping Beauty awakens," Cristina drawls in her typical robot-like nature. Izzie shoots her a glare, but Alex rolls his eyes and replies, "I see you're all here."

"Well, um. Yeah," O'Malley mumbles. He gets the sense that someone - Izzie - must have forced him to come and 'be supportive' or whatever shit she's been forcing down everyone's throat the past few days. And Meredith, too, with her whole 'he's our people' crap.

They lapse into an awkward silence, the only kind he's been getting lately, where everyone wants to ask him questions but they're too afraid to voice them and he doesn't really want to answer them, either. Finally, he heaves a sigh. "It's ALL, as I'm sure everyone's already told you." He sends a pointed look at his housemates, who have the decency to blush and look down.

"Well, whatever. You've got cancer, blah blah, so will 39.6% of people in their lives. Big deal. _We_ have to rotate off your stupid interns until you get back," Cristina accuses, ignoring the others' horrified looks. Her sad eyes, though, betray her sharp words, and he mentally thanks her for not treating him any differently.

"That's just too bad for you, Yang," he shoots back, and they fall back into familiar, comfortable banter.

After a few minutes of this, he says, "Seriously, though," and leans back in his chair. Izzie's making food and George is helping her, while Meredith and Cristina are perched on the counter. "What's happened at the hospital? Besides this, of course."

"Oh, trust me, you're old news," Cristina says with a roll of her eyes. "Not that anything else is out of the ordinary. Just sex, scandal, and surgeries. You know. The usual."

"Apparently Hahn and Callie are… you know…" Meredith says, smiling. Cristina groans at the mention of Erica Hahn.

"Wait, what? They're lesbians?"

"Apparently."

O'Malley quickly changes the subject, dark red forming on his cheeks at the mention of his ex-wife.

Izzie comes over with enough food to feed a herd of hungry lions and dumps three quarters of it on his plate. "Eat up," she commands.

He swallows and glares at her. He was feeling fine before, but now, the smell of food has made him slightly nauseous. And the last thing Alex wants to do is throw up in front of O'Malley and Cristina. Or anyone, for that matter, but the other girls have seen him vomit in at least five different colors the past week, so he's a bit more comfortable around them.

Still.

"Izzie. I couldn't eat this much even when I wasn't throwing up all the time." Not to mention that everything's been tasting pretty damn metallic since he started chemo.

Besides, it's way too much for one person. He starts to protest once more, but the high-pitched ring of the doorbell cuts him off. _Thank God_.

"I'll get it!" Meredith hops down from the table and rounds the corner, disappearing from view.

"Alex, I'm serious. You haven't eaten in forever." She turns back to him, a golden eyebrow raised and a hand on her hip. Even though she's being annoying as hell, he can't help but think back to forever ago, before Olivia and Denny and George and Rebecca/Ava and cancer, back when his own hand was on that very same soft, the other one pulling off her clothes, her tongue buried deep in…

"Alex!"

He blinks, conscious of the warm feeling spreading on his neck and cheeks. "Uh…"

"Did you hear a thing I just said?"

"... No."

"Ugh, Alex, please. I'm trying to-" Izzie's voice is cut off by the sound of Meredith clearing her throat.

"Guys," she says, an awkward smile painted on her face. "Say, 'hi'." And Bailey, the Chief, and Rebecca Swender round the corner.

* * *

Cristina, O'Malley, and his housemates clear out in a second.

It's just Alex and them, sitting around Mere's dinner table like it's the most normal thing in the world. The Chief's eating one of Izzie's muffins, and Bailey and Dr. Swender are drinking coffee out of the bright yellow mugs that she bought at some yard sale a few months ago.

"Look. Um, I know what you're trying to make me do, and that's really not appropriate. I'm not gonna change oncologists, okay? It's not your decision. At all."

"Karev, just shut up," Bailey says, matter-of-factly. "Let me speak."

The Chief clears his throat uncomfortably and sets down his muffin. "Bailey… Maybe adopt a… kinder tone?"

"He doesn't need a 'kind tone', Chief. He needs to hear the truth, and if that means I have to be frank, so be it." Bailey sighs and turns back to Alex. "Okay, maybe you're right. Maybe this isn't appropriate. Alex, I want the best for you. I want you to get better, and I know, I know that we're pushing it right now. I'm sorry. But, I'm not going to stop."

"Miranda-" the Chief began.

"Chief, you shut up," she replied, as nonchalantly as stating the weather.

Alex stifles a laugh.

Dr. Swender cough inconspicuously into her elbow. "If I may," she starts, her eyes drifting pointedly to Bailey and then Alex, as if daring them to interrupt her. "Alex. I agree with Dr. Bailey, obviously, because I am here. I have taken an interest in your case because I think you're a wonderful doctor and a good man" - he internally scoffs - "who deserves a fighting chance against your unfortunate illness. And I think I can greatly improve that chance."

"Also," the Chief says. He leans forward, his brow furrowed and eyes dripping with a sympathy that makes his already upset stomach churn. "You'll need your cancer team immediately at hand if something were to happen to you at work."

Alex blinks, unsure if he'd heard clearly. "Wait. I can go back?"

"There's no reason not to let you go. I'm sure you've already worked something out with your… oncologist, and as long as a schedule is made and you aren't pushing yourself too hard, well, I don't see why not."

He looks at the three faces, one of which he barely knows, the other his boss, the last his boss _and_ the one person he actually sort-of trusts. All of which, if he agrees to this, will see him at his weakest, will eventually have to tear down his supposedly invincible walls, will break down all he has built up the past few years.

And all of which, somehow, care about him.

"Okay." And being weak is simpler than he'd imagined.

* * *

It's only around nine o'clock at night, but he's exhausted and ready for bed. He's standing at the kitchen sink, drinking some water when Izzie walks in.

"So… Dr. Swender, huh?"Alex turns at the voice. She's standing there, her blonde hair pulled back into a messy bun, her lips spread in a soft smile. "I'm glad."

"Yeah," he replies, shifting his weight forward until he leans against the counter. "Bailey pressured me into it."

"Did you expect any less than that?" she laughs, and shakes her head. Her eyes shine with happiness and she lets out a little squeal. "I'm so glad you're going back to work tomorrow."

"No, I'm not going back tomorrow. I have to work out some stuff with Dr. Swender. I'm scheduling my treatments at night, so that they don't interfere with everything as much. But definitely Wednesday, since I'm changing the whole schedule and everything." Work is definitely the best thing that will come out of this whole arrangement. The sympathy might be suffocating, but at least he can be a surgeon. Even if he won't be the very best. At least he'll be there. At least he'll still be doing stuff.

"I'm really, really glad, Alex," she says, and he can tell she's barely containing a dance and a ginormous hug and an entire party she's no doubt considered throwing.

Ha.

He can just imagine it: _Congratulations, Alex, On Getting Cancer and Being Able To Go Back To Work!_

"Like, really glad." She sighs contently, swinging her arms back and forth. "You know, you wouldn't really expect it, but things have been different without you. Bad, different. Without the asshole comments and twenty-four seven bitching, things have been really dull."

"Don't you have Yang for that?"

She laughs. "True." A pause. "But she's not Alex." She looks at him then, her expression one he hasn't seen in a long time. It's a familiar look, though, and a feeling of warmth spreads in his stomach. He's missed her.

They fall into a comfortable silence, and he's glad that they can do this. Talk without being awkward, even after everything they've gone through, everything they're still going through. It's nice. Nicer, obviously, would be the alternate alternative, but you can't have it all, right? They _could_ be friends with benefits…

"Have you told your family?"

He blinks, jerking his head up, hoping he's heard her incorrectly. "What?"

"Have you told your family about your diagnosis?" She blinks owlishly, and at that moment, the pure innocence and simple caringness in her wide brown eyes have never been more aggravating. What the hell is she doing, thinking it's okay to _bring up_ his family? It's the unspoken yet universally followed rule of Alex Karev. Everyone follows it, even people who think terribly of him. And she's just broken it. "You haven't told them? Alex, this is serious, you know. This is a big deal. This is-"

"Don't you think I know?!" he bursts out, interrupting her mid sentence. She takes a half-step backwards, and he thinks, _good_. _Be afraid, go away, shut up._ "I know it's a big deal! God, of _course_ I know! I'm the one with the cancer, I'm the one who has to deal with all this. _Not you_. And I'm also the one with the messed up family that has enough shit on them that they don't need to know about the crap that's been happening with me, okay? You of all people should know why I can't have them know. When was the last time you talked to your mom?" It's a low blow, and cruel too, but it's all that he knows how to do. It's all he can think to say. Insults have always been his only defense.

Izzie stiffens, her facial muscles tightening in one swift motion. She doesn't back down, though. Instead, she steps forward and says, voice quiet and calm and steady, "you might have a point. But I don't have cancer."

He scoffs. "Are you serious?" He doesn't know what else to say. He's too tired to say anything else, too tired to come up with a good comeback, too tired to fight with anyone, least of all Izzie, who has the grand prize for most consistent arguer, especially when it comes to Alex.

"I'm going to bed," he mumbles.

"Alex, please. You have to tell them," she tries again, her hands reaching out to brush against his arm. Her fingers are hot against his perpetually icy skin, and he shudders slightly and jerks back out of reflex. She squeezes her eyes shut and lets out a low breath, but stops persisting.

"Goodnight, Iz."


	4. Chapter 4

Title: and we see the exit sign (and we see it all)

Author: darknessinastateofmind

Summary: "He always knew, one day, that he would get what he deserved. He knew, and he knows." In which Alex Karev is diagnosed with cancer. In which everyone and everything falls apart before it all falls together.

Warnings: Cancer, language (Karev's got a nasty mouth in this one)

Pairings: Eventual Alex/Izzie

Disclaimer: I do not own Grey's Anatomy nor any of the characters mentioned. All rights belong to the owner.

Author's Note: Hi everyone, it's me again. I'm kinda shoving a lot of events into one, so the times don't match up, and there will be mentions of stuff from later episodes and seasons. But basically, this is an AU where Izzie doesn't get cancer, Alex does. I know there's been a lot of breakdowns from Alex so far, but I really do think that he's the type of guy to act all tough, and then build it all up inside of him until he freaks out. So, yeah, I know they're getting a tad tedious, but bear with me. Hope you enjoy, and please review/comment.

* * *

 _There's no race, there's only a runner_

 _Just keep one foot in front of the other_

 _There's no race there's only a runner_

 _1, 2, 3 even when you get tired_

 _Just keep one foot in front of the other_

 _There's no race, no ending in sight_

 _No second too short, no window too tight_

 _\- Two Of Us On The Run, by Lucius_

* * *

 _CHAPTER v._

He wakes up the next morning with a bald spot the size of Alaska on the back of his head and a pile of brown hairs on his pillow, scattered like the little flakes of March snow that fell just a few months ago. He sits there for a few minutes, holding the small hairs in his hand, marveling at them. His hair is so… soft. So tiny and insignificant, he doesn't know why he was stressing over it so much just yesterday.

And then he stands and goes into the bathroom and catches sight of the bald spot on the back of his head. Sees what cancer is doing to him. He sees his terrifyingly pale pallor, he sees the dark bags underneath his eyes, he sees the prominent concave of his cheeks. And he sees the bald spot, the bald spot that is bigger than Alaska. His skin is so white underneath all that hair, and he runs his trembling fingertips over the large area.

Suddenly, everything crashes into him like a hurricane, like a freaking truck is driving full speed into his ribs, knocking the breath straight out of his lungs. God, it hurts. He hurts. He can't breath, he can't breath, he can't breath, can't breath can't breath can't breath…

He struggles against his closing throat, clawing desperately for some oxygen to enter, anything, so he can just fucking _breath, for God's sake_. Alex is faintly aware that he backs up against the bathtub, his legs slamming into the sides, and he trips, landing ungracefully onto his butt. He might be crying, he might be suffocating to death, he might be disintegrating for all he knows. Which is nothing. He knows nothing, except that he can't do this anymore.

 _I CAN'T DO THIS ANYMORE!_

 _Oh God. Oh God, I can't do this, I can't do this, can't do this can't do this._ He pulls at his hair, his fingers shaking as the strands fall out like pieces of

Suddenly, there's more noises, a high pitched scream ("Oh my God! Help!"), and words, his name, over and over: "Alex, Alex, open your eyes, Alex, can you open your eyes for me? You're okay, it's gonna be okay. Alex, can you hear me? You're having a panic attack. Breath with me. Can you do that? Come on, Alex, that's right, that's perfect. Slow, deep breaths, you got it…"

Shepherd? What the hell?

Derek Shepherd is crouched in front of him, his strong arms pressed against his shoulders, grounding him to the floor. Meredith and Izzie are kneeling behind him, their own eyes mirroring the man's piercing blues, which are dripping with sympathy. Alex closes his own.

He sucks in a deep, wavering breath, trying to quell the overwhelming emotions bubbling up inside of him. Tries not to die from embarrassment. "Can you please go," he whispers, meaning to sound commanding, but he instead sounds timid and scared. No one moves, and Alex jerks away from the arms pressed against his shoulder, covering his face with his hands. "Get out!"

"Derek, Meredith, I got it. You can go." It's Izzie's voice, quiet yet meaningful. Shepherd hesitates for a half a second, then leaves, taking Meredith with him. Alex feels Izzie sliding against him, squeezing into the narrow space between the sink and his body. It is silent, save for his labored breathing and pounding heart and Meredith and Shepherd's quiet murmurings outside the door and the ferocious rain, pounding against the roof.

Silence is irrelevant.

"It's okay," she says soothingly, her fingers grazing against his head, sending shivers down his back. "Let it all out."

He's empty, though. He's let everything out. There's nothing more to give. He's got nothing left.

"Alex, hair grows back. You'll beat this, and everything will be okay again, yeah? Everything grows back, it'll all come back as soon as this is over," she says, still petting his head like he's her goddamn puppy. She's looking at him with those huge, sympathetic eyes, and he can just imagine her thinking _poor Alex. Poor, little Alex._

It's disgusting.

He yanks away from her reach and stands up, running a shaking hand through his thinning hair. "I don't need this, you know? I - I don't need you… _pitying_ me, or whatever this is. Okay? So stop because I don't need this. I don't need you."

"I-"

"Oh, and Izzie? That thing you said about hair? How it'll come back? Well, news-flash, so does cancer." And with that, he throws open the door and stomps into his room, ignoring the tears burning in his eyes and blurring his vision.

It kills him that she doesn't understand. Yeah, he knows hair grows back. He knows that everything will eventually be back to normal. He knows. And he also knows that he might die. That, even if he survives, he'll never be the same.

That's the part Izzie doesn't understand. That's the part no one understands. This, this _thing_ he's become. This weak, pathetic, crying, panic attack-having excuse of a man isn't him. He's tough and brutally honest and he never, _never_ , let's his guard down. Oh, and the _real_ him actually has a freaking sex drive, and the real him doesn't look like Gollum from The Lord Of The Rings. The real him is a man, a person. Not a slimy, bald, underground creature.

Whatever. He knows it's stupid that he expects her to understand him even when he doesn't understand himself, but for some reason, he still wants her to.

He needs at least one person who does.

* * *

After his bathroom freakout, Alex isolates himself from everyone else, Izzie especially.. He shaves his head and digs through his closet for an old baseball cap to hide under, and Izzie goes out one day and comes back with a bag full of those knit hats. Beanies or toques or whatever they're called. She buys twenty of them. In every single color on the fucking planet. She leaves the overflowing shopping bag by his door, and doesn't say a word when he doesn't say thanks. She smiles, though, when he leaves the house that day wearing the green one.

He goes through treatment and sleeps and work. Pretty much stupid stuff. The occasional, less than intern level sutures. Everything's "low stress". Or, scut work. He's not cleared for surgery, so he basically spends the few hours he's allowed to work in the hospital doing charts, being too tired to do charts, and hiding.

Alex's first day back was a huge shock, for him and for everyone else. Everything's changed. Hahn's gone, replaced by some apparent cardio god. Altman. Cristina's practically worshipping the ground at the woman's fucking feet, looking even more like a stupid idiot than usual. There's a new peds doctor, Arizona Robbins, who Callie Torres is probably screwing around with. And apparently, O'Malley's thinking of enlisting in the army.

Also, Derek moved in, which is so awkward. He never pinned the guy as the sitting by the bedside holding a silent vigil type of dude, but he's been more or less doing that. He's pretty sure Meredith made him hang around Alex twenty-four-seven to make sure he doesn't wig out and die.

So there's that.

The hospital is crazy. He's gone for a few weeks, and boom. Nothing's the same. He feels different, too. Not just because he's sick now and basically at the mercy of a bunch of blood-thirsty doctors. Not just because he's got a black beanie on his head that he refuses to take off. Not because he spends almost every night bent over the toilet and holding tissues against his nose. Not just because his pride is slowly leaking out of him with every piece of hair he loses, with every drip of poison that leaks into his crumbling body.

He's different. And just because he's changed doesn't mean the hospital gets to look at him like he's some sideshow freak.

He knows they're worried about him. He knows they only talk about him because of that reason. Still. They whisper all the time, whispers of which only cease when he's within a two feet radius. Like, seriously? He's a cancer patient, not Helen Keller.

There are a couple people who are the absolute worst. Lexie, for one, will not stop running over every second he slows down or coughs or closes his eyes for a half second. It's like she's scared he'll croak on the spot, drop dead right there, just because he stopped to blow his goddamn nose.

And then there's that peds chick. Robbins. She doesn't know a thing about him, but he was put on her service on his third day back, and she now thinks he's got some great future in peds. AKA, a good future in being a babysitter. Of course she'd think that, now that he's got cancer, right? Apparently, Bailey put in some words about how he'd be good. So she's been really freaking annoying lately, with her cheerful smile and positive attitude that isn't so much as contagious as it makes him want to scream _SHUT THE FUCK UP_ at the top of his lungs _._

Bailey and the Chief sort of suck, as well. Both are on him every single minute he's at the hospital, telling him to "take it easy" and asking him if he took his meds yet. Basically, they're acting like the freaking parents he never had. He blew up at the Chief the other day, but it's like the man's got a bullshit radar. He's still being a persistent ass.

Correction: It's not just Bailey and Chief Webber. It's every single fucking thing that lives and breathes and has a mouth to worry about him.

It's everything.

* * *

Bailey's speaking, but everything is slurred and unclear. He's there, standing in his scrubs and lab coat and brown beanie, but he may as well be picking corn back in Iowa. It's hot and stuffy and he's being swallowed by his clothes, being crushed to freaking death by the damn walls of the suffocating hospital.

He hurts. His limbs and joints ache like nothing else, his head feels like it contains a miniature marching band, he's probably got a fever, and he's vaguely nauseous.

"-post-ops. O'Malley, you're needed in the Pit. Uh, Yang's with Altman, Grey and Stevens are with Shepherd," Bailey commands tersely, handing out charts as she speaks. His fellow residents disperse with chatter and anticipation.

Alex is pretty sure he hasn't been assigned to anything by Bailey, but he isn't completely sure. All he really wants to do is find a nice bed and sleep for a few hundred years, but he's still got a sort of reputation, though it's been pretty badly tarnished. He can't just admit he feels unwell. So he walks up to her, hoping against hope that he's walking in a relatively straight line.

"Uh, Dr. Bailey. You didn't assign me to a case. Does that mean I'm doing charts again?"

The short doctor turns around to face him. "No, Karev, it means you are going home to sleep. You look terrible, and frankly, the last thing this hospital needs is their residents dropping to the ground like flies. Go home."

"But-"

"Karev. If you don't go, I'll personally request someone to physically put you into a wheelchair and wheel you out of here. Hell, I'll even do it myself, if I have to," she warns.

"I'm fine, Dr. Bailey. Seriously. Look, I-"

"Go home, Karev!"

He rolls his eyes. He's fine, really, he is.

 _Yeah, you're fine. And that's why you can't walk in a straight line._

 _Shut up._

"Karev, you better be on your way to the resident's lounge right now to pack your stuff up!" Bailey was already walking in the opposite direction, but her voice rang out clear and commanding, daring him to do differently.

He mumbles complaints under his breath for the sake of keeping up his rep, but all he can think is: _Thank you, God._

* * *

He wakes up to the demanding sound of the doorbell, high-pitched and aggravating. "Who is it," he mumbles into his pillow. His soft, wonderful, comfortable pillow. In his soft, wonderful, comfortable bed. Which he needs to get out of now, because some goddamn idiot is ringing the doorbell like they'll die if they stop.

Alex stumbles out of the bed with as much grace as a drunk - unsteady and dazed. That's how he feels, and everything is blurring like crazy.

He wobbles down the stairs, his head pounding with every step he takes. The doorbell doesn't stop ringing. If it's possible, it sounds to him like it's growing even more incessant.

"I'm coming!" he shouts, wincing as the loud noise vibrates painfully in his brain.

He pauses with his hand wrapped around the door handle, catching his breath for half a second. Then, he wrenches the door open.

 _Oh, fuck_.

"What are you doing here?"

"Hi, Alex." His little sister smiles weakly, and he contemplates death.

"Your girlfriend called me. Izzie, I think? She told me-"

" _Izzie_ is _not_ my girlfriend, okay? Amber, please. Y-you can't stay. You have to go. I mean, I appreciate you coming or whatever, but Mom needs you. You have a life you need to go back to. And I have one as well. Please. I'm begging you. Go back to Iowa." He stares at the girl (no, _woman_ ) in front of him who, last he saw her, was lying in a hospital bed with her throat half slit open. And, before that, she was ten years old. A baby. His baby sister, who he was supposed to protect, supposed to actually be there for. He's spent the last eight years telling himself that a one-thousand dollar check a month equals love, equals everything he's missed out on. But time has a cruel way of passing by, and now his baby sister is seventeen years old. The woman standing on Meredith's front step isn't that little girl from so long ago, the little girl who wouldn't go anywhere without her stuffed dog, the little girl who worshipped the very ground he walked on.

The woman standing on Meredith's front step is scarred and traumatized and has been through hell and back. And, she is beautiful.

God, she's beautiful.

He feels tears pin prick his eyes, and he swallows thickly. "You - you… you should go."

Her eyes flash, and she opens her mouth to speak, but he cuts in before she can begin to protest. "Please. Go. You can't be here."

"Alex, please-"

"Amber. Leave." He forces his voice to sound like the douchebag Alex he was once so proud of being. Now, it just tires him out. The effect is lost anyway when his voice crack on the second syllable of his baby sister's name. "You can - you can't stay. I can't take you. My heart… it can't take you."

She blinks back tears, hurt painted so clearly on her face. "Please. You're my older brother. I haven't seen you in a year, and before that, it was eight. _Please_ , Alex. You left us so long ago. And now - you're sick, and I can't just _stay in Iowa._ It's not fair." Her expression changes from remorse to anger in half a second, and he already knows what's coming before she opens her mouth.

"You didn't tell us you have _cancer_ ," she looks at him with an expression of such hurt and anger Alex ducks his head in shame. "You have _cancer_ , and you didn't tell us?! Why? Because of your goddamn ego? What - did you think we wouldn't come? Well, I did. I'm here. And I want to help you. I want to be here for you."

 _Like you were never here for me_ , is what she means but doesn't say.

He forces his face to a neutral expression and controls his eyes so they stay cold and feelingless. "Amber, when are you going to understand? I don't need you to be here, and I sure as hell don't want you, either. Honestly, you just wasted a couple hundred dollars in gas money coming to Seattle. Get out." He forces the words out in an airy, indifferent tone.

He is drowning on the inside. It takes everything in him to restrain from begging her to stay, from asking her to tell him everything about her, everything that he's missed. And the second those cold words leaves his mouth, he knows that he'll never get to know those things about her.

"Son of a bitch," she hisses, turns on her heel, storms to her car faster than he can blink.

The roar of her broken-down engine resonates in his brain as everything suddenly becomes a blur of bright colors, and he falls to the ground.


	5. Chapter 5

Title: and we see the exit sign (and we see it all)

Author: darknessinastateofmind

Summary: "He always knew, one day, that he would get what he deserved. He knew, and he knows." In which Alex Karev is diagnosed with cancer. In which everyone and everything falls apart before it all falls together.

Warnings: Cancer, language

Pairings: Eventual Alex/Izzie

Disclaimer: I do not own Grey's Anatomy nor any of the characters mentioned. All rights belong to the owner.

Author's Note: Okay so this chapter will be a COMPLETELY different set-up than the others were. It will be in alternating perspectives between a few characters. I'm not sure about this. A bit nervous writing in all these POV's. Also, I AM NOT A MEDICAL PROFESSIONAL. All of this information is taken from the internet and used with a bit of a creative license. Please review/comment, and thank you for your continued support!

I'm so sorry for the late update. In truth, I had this completely drafted in late May, and was just working through editing when I went to Taiwan to volunteer at an orphanage for a few months. There was no WiFi, and I had no way of posting or editing any further! Anyway, the next one will not take as long, but I can't make any promises as I'm currently drafting my first novel and school starts soon so… Sorry!

* * *

 _It's dripping from the ceiling_

 _It's everything I see_

 _And that old sinking feeling_

 _Is rushing over me_

 _Everybody knows what the aching means_

 _Nobody wants to belong_

 _Somewhere in between what you wanted_

 _And what you didn't want_

 _-The Aching, by Broken Twin_

* * *

 _CHAPTER:_ e.

 _Izzie_

Meredith's jabbering on about some simple appendectomy an intern completely messed up. Izzie sighs, and says for what seems to her like the twentieth time: "They're just interns, Mere. Don't expect them be perfect, okay? We messed up all the time in our intern year."

"Yeah, but an _appendectomy_? I mean - it's not like it was the first solo surgery this idiot's ever done - it wasn't even a damn solo surgery! Do you know what he messed up on?"

"Yes, Mere, you've told me already."

"He messed up on the polyglactin stitch. _The stitch_. He almost killed a patient with the _appendix_ while closing him up."

"Don't you have Cristina to complain to?" Izzie replies, propping her elbow against the armrest and resting her cheek in her hand.

"She's on call tonight, Izzie, so I have to complain to you. But, seriously. We were not that stupid when we were interns."

She heaves a sigh. "No, we weren't. We were just cutting LVAD wires and stealing hearts. "

"Hey, that was just you. Anyway, I don't think we were that stupid to have messed up a simple stitch!" Meredith waves her arms as she speaks, and the car jolts slightly to the left before normalizing again.

"Keep your hands on the wheel."

Meredith sighs and lets out a groan.

Izzie looks over at her friend. "It's not really about the intern," she states. Obviously it's not. Alex has been haunting everyone's actions and moods lately, making everyone snappish and grumpy. And he's not even dead.

( _Yet,_ the evil, pessimistic side of her whispers.

 _Shut up!_ the angel replies.)

"No, it's not."

"It's Alex."

"Yeah. Uh, I don't how to bring it up to him. I think he's depressed," Meredith admits. "And I think he needs help."

"Ha. Good luck bringing that up to Alex."

"I know. He's impossible."

Izzie sighs and swallows. "I did something bad."

"Stealing hearts, bad?" she says, her voice tinged with morbid amusement.

"Um… for Alex, pretty much that bad. I, uh… I called his sister. She's coming. She might be there, actually."

"Izzie!"

"I know, I know. He's gonna kill me," she moans. "He'd deliberately told her not to contact his family, but what the hell was she supposed to do? He has cancer, and he didn't tell his family. It's ridiculous. Her mom isn't perfect, but she'd still tell her if she had cancer!"

Probably.

Meredith shakes her head and turns into their street. "You'll have to-" She gasps suddenly, and Izzie looks up from her phone.

"Is that…?" There's a pile of person on the porch. Her heart suddenly pounds in her chest. That's not Alex, it can't be. Please don't be Alex.

"Alex," Mere confirms, voice grim. She jerks the car to a stop and whips open the door, Izzie hot at her heels.

"Oh, God." She drops down next to the prone figure. Alex is deathly pale, his body soaked in sweat.

Izzie stands, frozen in place. "Is he-" her voice breaks off into a choked sob. Before she can finish her second, his body starts shaking, like a fish out of water. A seizure. Meredith rips of her coat and shoves it under his head, and a trickle of blood comes out of his mouth.

"Call an ambulance." Her voice is tight and commanding, but she catches the hint of fear in her voice. The smell of urine fills the air. He's pissed himself.

Izzie pulls out her cell phone and dials 9-1-1 with shaky fingers. "Come on!" she shouts. "Connect, connect, connect…"

" _9-1-1, what's your emergency?"_

"My friend just collapsed. He has precursor lymphocytic leukemia," she says, her calm voice the exact opposite of how she actually feels. "He's having a seizure right now. We're at six thirteen Harper Lane." She swallows, finally cracking. " _Please hurry_."

 _Cristina_

Alex is not someone she thought she'd ever tolerate, nevermind like. But, over the years, she's done just that. Who knew Evil Spawn could be more than a grade-A asshole. Even though Cristina has decided that maybe Karev isn't the worst, that doesn't mean she'd ever admit it to the guy.

Maybe not even to herself.

He's rushed in on a gurney, looking pale and sweaty and sick. Meredith and Izzie come in half a second later, their faces haggard and tired and terrified. Izzie's crying in a silent, affecting way that fills Cristina with a fear that shakes her to the bone and maybe even farther than that.

"It'll be okay," she says quickly, and then grabs the other side of the gurney. The paramedic rattles off his stats, all bad and worrisome.

"Okay, page Nuero, and get him a CT." Her voice is strong and commanding and professional as hell, like she actually knows what she's doing. Like she's not terrified out of her mind for Evil Spawn, like she's not regretting all the times she's undermined him. Like she's not going soft for _Alex_ , of all people, like she doesn't actually care about him.

She _cares_ about him.

And it's not that surprising, she realizes. She's sitting next to Derek, looking-but-not-really at the CT scan of Alex's brain, listening-but-not-really as he talks about an intracranial hemorrhage, and it may be the first time she hasn't been excited to learn, excited to cut open and slice and dissect. Because this is Alex's messed up brain. And as much as she loves messed up people and fixing them, this is Alex's. Who doesn't deserve this.

(No matter how much of an ass he is all the time.

And, _God_ , he is such a douche sometimes. But because he has cancer, no one is allowed to call him out on his bullshit. Except for her, of course. Which makes her look like a soulless bitch, but whatever.

She was never known for her kindness.)

* * *

Dr. Swender shifts in the seat next to her's. "My main concern is the spreading of his cancer. I'd like to get a CBC and biopsy."

Cristina swallows. "And if it has spread?" she asks, already knowing the answer.

"Well, that all depends on the extent of that. But I think a bone marrow transplant would be the best course of treatment."

Derek looks at her, then back at the scan. "I need to get in there and stop the bleed, first. It's too large to treat non-surgically. Yang, get him prepped and scrub in."

And she does. As she's washing her hands, she wonders if she can do this. If she can dig into the brain of of her friend.

The logical part of her knows that this is just a craniotomy. Derek's done hundreds of them in his career. Cristina herself has seen a good number of them. _Alex is going to be fine. Alex is going to be fine. Alex is going to be fine._

 _He's fine, he's fine, HE'S FINE._

She's got this. She can do this.

Anyway, it doesn't matter if she can or can't. She's doing it, anyway, because she's Cristina Yang, and that means she's a robot with no feelings when it comes to surgery. This isn't Alex Karev, her friend, her fellow resident. This is a broken body that she's going to help fix.

She can.

She has too.

 _George_

George _really_ doesn't like Alex Karev. And why should he? The guy gave him syphilis. He's stolen everything from him - from girlfriends to surgery's to respect. He's dicky and cocky and gross and inappropriate. And he's sick.

So George's not allowed to actually hate him to his full potential, because while Alex is all these terrible things, he's also a cancer patient.

It's not fair.

He's certainly not as bold as Cristina, who continues to fight with Alex, despite his protective covering that is cancer.

And George knows that he sounds like a pissy five year old whining for attention, screaming the infamous words " _it's not fair!"_ whenever he doesn't get his way. But he's mad, okay?

George's mad that Alex has cancer, partially because, from what he's experienced, it _really sucks_ to have cancer. George is mad that Izzie loves Alex (no matter how much the both of them deny it with snide remarks and rolled eyes). He's mad that Alex is looking into peds, because it's even harder to hate the guy if he saves little children.

Most of all, he's mad that he doesn't hate Alex Karev. He's mad that he doesn't even really dislike the guy.

Right now, he's sitting in the gallery, holding the trembling hand of a silently crying Izzie, watching Alex Karev's brain being dug open. Cristina's there, looking strong and robotic and stiff, and George wonders how she does it. Sure, she doesn't like the guy almost as much as he does, but she looks so normal it's unsettling.

Pretty much half the hospital staff was in the gallery, before the Chief kicked everyone out except for a select few. Now, it's just George, Meredith, Bailey, and Izzie.

"It'll be okay, Izzie. Don't worry, okay? Derek is the best there is. He'll be okay," George whispers, and offers Izzie a tissue.

She accepts it and blows her nose, then shoves her face into her hands. And then she chuckles a little. George winces. Izzie's two breaths away from full blown, hysterical laughter, and that means trouble for everyone.

"Come on." He grabs her arm. "Let's sit outside, okay?"

Izzie nods and stands up like an old, tired man; she's drained both physically and emotionally. "Tell us when it's over." Meredith looks like she wants to go with them as well, but she stays.

She's stronger than George. He thinks, maybe, one day, he can be as strong as her. But until then, he sits outside. He runs away, he lets others stay.

It's what he does best.

 _Meredith_

The surgery is finished, and it all goes by without so much as a dropped scalpel. Derek and Cristina exit the OR looking twenty years older than when they entered it. Meredith takes a few minutes sitting inside the gallery with her eyes closed, trying to ward off her fears and the unwelcome swelling of tears. Bailey and Chief Webber both squeeze her shoulder as they pass, and suddenly she's filled with such a relief that someone else understands this overwhelming desire to scream and cry just as the danger's passed.

Seeing Alex like that, so pale he was almost gray, lying in a slumped heap outside the house…

It's an image she'll never be able to rid her mind of.

Eventually, she's able to gather her overwhelming emotions and bury them deep inside of her.

 _Alex should be waking up by now._

And so she pulls herself together with a deep breath and a swipe of her eyes with her hands. Meredith stands and leaves the gallery. She passes by a sleeping, puffy-eyed Izzie leaning on George. She pauses for half a second to assure him that it went by without a hitch, and _why don't you guys head on to the house because the Chief's given us the night off?_

Meredith doesn't wait to hear their response. She heads into the oncology ward and stops right at the door to Alex's room. The door is wide open, and Derek as well as Dr. Swender are both inside, conducting a number of tests to test Alex's awareness.

He's awake.

Cristina is standing nearby, looking awkward and sad and uncomfortable, somehow all at the same time. Derek catches her peeping by the door and waves her inside. "He's awake." Derek repeats her previous thoughts with a tired smile.

"Hey, Alex," she says, walking around Cristina to get closer to him.

And what a sight he is. Alex has lost so much weight this past month, through chemo and radiation and the wonderful thing that is vomiting everything that goes past his lips, but this grayish blue bald thing is almost a skeleton. There is a bandage around his head. Underneath it is a scar from the procedure, just one more to add to his growing collection.

She knows it's cliche as hell, but, god, he looks so tiny in that hospital bed. Those IV's and machines all surrounding her. It's a setting she's familiar with. But not with Alex plopped right in the middle of it.

"Mere… hey," he whispers and smiles dazedly at her. He reaches his hand out to take hers, but his depth perception is shot to shit right now, and he ends up grabbing the bottom of her shirt instead. She takes his clammy hand and wraps hers around it.

"It's the good stuff," Derek says. He resumes his examination, and Meredith makes small talk with a dozy, barely there Alex. Eventually, he falls asleep, mid-sentence.

"Let him rest."

The four of them step out of the room, and it's then that Derek's smiling facade falls. "Meredith…"

"Wh-what is it?" she asks, staring at the resigned looks on her boyfriend and best friends faces. "I thought the surgery went well. It did, didn't it?"

Dr. Swender is the one who answers her, and her voice is terse and all professional and solemn: "Yes, it did. But what I'm worried about is the progression of his cancer. We just got the results of his CBC back."

"Um, Mere…" Cristina says, and averts her eyes and shakes her head. "It's not looking good."

Meredith swallows. When she finally speaks, her voice is raw. "What now? A bone-marrow transplant?"

"Yes, a transplant would be the best shot he's got. I just made the call to UNOS. He's on the list." Dr. Swender shifts, and Meredith is overwhelmed with the weirdest desire to punch her in the face.

"What are his chances of getting marrow in time?"

"Well, even though his white blood cell count is much more elevated than previously known, I'd say his chances are pretty good. He was in good health otherwise, he's young and he's strong. I wouldn't count him out." She pauses. "Of course, that's only if he's willing to fight. I suggest some therapy sessions would do him good. He's got quite a battle ahead of him. I've seen the strongest of patients end up losing because of their mental state."

Just then, Izzie and George appear. They both look exhausted, and George's eyes are suspiciously rimmed with red. "How is he?"

Derek and Dr. Swender take their leave. Her boyfriend gives her a kiss and a hug, his eyes sympathetic. Meredith doesn't think she'll be able to repeat what she was just told without breaking into a million pieces of nothing, but Cristina's looking just as drained, so she does it anyway.

Izzie looks ready to sob or break out into hysterical laughter, and George is just confused and shocked. And Cristina is a rock, and Meredith has to be one as well, because sooner or later a rock has to break, so she has to be strong when it happens.

She's got to be strong for everyone, and tries to ignore the little pieces of herself on the floor.


	6. Chapter 6

Title: and we see the exit sign (and we see it all)

Author: darknessinastateofmind

Summary: "He always knew, one day, that he would get what he deserved. He knew, and he knows." In which Alex Karev is diagnosed with cancer. In which everyone and everything falls apart before it all falls together.

Warnings: Cancer, depression, references to (past) self harm, language

Pairings: Eventual Alex/Izzie

Disclaimer: I do not own Grey's Anatomy nor any of the characters mentioned. All rights belong to the owner.

Author's Note: Hey, I'm back! I've brushed up a little (okay, a lot) on the emotional trauma Alex is dealing with. And not just because of cancer, but because of everything, really. So, I'm excited for you to read this chapter, as it really goes into depth when it comes to his mental state! I didn't realize how dark it was getting until I'd finished writing it, but, oh well. Again, I'm not a medical professional and all the information here is found from the internet and used with a tiny bit of a creative license. I hope you enjoy this, and/or please review and comment! It might motivate me to update faster… :) Also, sorry about the difference in page breaks. FF.N was being weird again.

/

 _Long way down_

 _Feels like a long way down_

 _Feels like a long way down_

 _Like a long way down_

 _So honey don't leave, don't leave,_

 _Please don't leave me now_

 _\- Long Way Down, by Tom Odell_

 _/_

 _CHAPTER m._

He wakes up to a dry mouth and an aching head. Awareness creeps in like fog, so slowly he doesn't even know he's awake until it happens. The incessant beeping of the machines around him only confirm where he is; the hospital.

Fuck.

Alex searches his mind for what could have landed him here. He vaguely remembers a plethora of colors and hitting the ground. What was he doing before he fainted?

Suddenly, he remembers. He remembers his sister, he remembers her words, he remembers his own. His stomach lurches, and he has to swallow back the urge to vomit everywhere.

"Oh! Dr. Karev! You're awake! That's incredible!" an extremely annoying, high-pitched voice chirps. It's one of Izzie's interns, whose name has completely escaped him. Or, it was never in his possession in the first place. "I'll go page Dr. Shepherd!"

"Wait," he whispers, hating the gross weakness in his voice. "What happened?"

"Uh, I don't know, like, every single detail, seeing as I was put on your case just an hour or so ago by Dr. Yang, a great honor, you know, because, like, you guys are good friends, right, and obviously, like, she would only put her best interns on your case and I, like, I guess I was so excited I didn't even, like, really read your chart very closely. Please don't tell me you'll, like, tell anyone, especially not, like, Dr. Yang, she's such a good surgeon but she's like really, really cranky, especially lately, and she'd probably kill me and, like, dissect all my insides if she found out I don't know every single tiny detail about your case, I'm so sorry I should probably just-"

Great. A talkative, arrogant intern with Yangphobia and an obsession with the word 'like'. "Just page Shepherd and Yang, okay?" he says, still too softly to have much effect, but gruffly enough to reinforce that wonderful 'I'm Dr. Karev and I will hit you if you annoy me' aura he had established before cancer, and smirks a little when the intern jumps and scurries out the room with a squeaked, "okay!".

"You damn near scared my intern to hell, Karev. Glad to know you still have it in you." Cristina walks in the room with a bemused expression.

"You stuck her with me on purpose," he mutters, but can't find it in him to smile back. Maybe it's because his head is killing him, or maybe because he basically told his little sister he didn't want her (when he wants her in his life so fucking bad, he can't even breathe sometimes, you know, because he misses her like an addict longs for drugs and he just wants to make sure she's okay and he wants her to smile and he wants to be the reason for her smile and he's just so tired of being alone, so fucking tired of it). Or maybe because everything is falling apart. Himself included.

"Maybe I did. Can't let you get too cocky, being away from those brats for so long." But she seems to see that his heart isn't into their banter, because she sighs and looks down at the chart.

"What happened?"

She sighs again, and sits down on the side of the bed. It squeaks slightly under the added weight "There was a complication. Intracranial hemorrhaging occurred. Luckily, we were able to catch it in time before any lasting damage occurred. You'll just have a killer headache for some time. It's just… another side effect, Alex."

There's something she isn't saying. Alex's known Cristina for years now, and they may not be Liz and Jack from _30 Rock_ (he's had a lot of downtime since cancer, alright?), but he's recognized the signs. It also helps that she's a terrible liar. "There's something else. My cancer's spread. Hasn't it."

"Alex…"

She's interrupted by Derek. He walks in with a chipper smile and those stupid, optimistic blue eyes. "Alex! You're awake! That's great. I'll just perform a few tests, and I'll have Dr. Swender come in and explain your situation to you."

"Situation," he says with a snort. "That's original."

He's released two days later, filled to the brim with chemo and shitty feelings.

Alex isn't speaking to Izzie. It's childish, the rational part of him knows, but… Well, it's not like he's known for his overwhelming wisdom and maturity. Plus, he's actually, legitimately mad at her. Calling his sister was really not cool. If it were anyone else who had done it, he would've done much more than ignore said person. But, well. It's Izzie.

He spends the majority of his time alternating between staring at the wall, being too sick to stare at the wall, sleeping, and throwing up. Not very different than his usual routines, but for some reason, everyone thinks he's depressed.

Which is completely insane. He's not _depressed_. Depressed is… Well, his mom, right? Depressed is constant crying and screaming and that terrifying imbalance between catatonia and raging hysteria. Depressed is everything he's _not_.

Depressed just _isn't_ him. That's opening a whole can of worms he's avoided his whole life, and he can't start now.

But Cristina comes in and lists hundreds of facts and statistics that make a bit of sense. And Meredith comes in and bombards him with all that 'you've got to be strong, Alex, because you have us' shit that's pretty much all she's been talking about this past century. And Izzie's just an emotional mess, and George is awkward and weirdly nice, and Bailey is gruff and worried at the same time, and everyone is just good to him. Why is everyone so good to him?

And he's just so tired. Physically, yes, but emotionally as well. He's so fucking tired of this support he's been getting. He's tired of being sick. He's tired of his life and his guilt and his past he's tired of ignoring Izzie.

That's it. He's not depressed. He's just sick and drained and tired.

/

Obviously, no one believes him when he says he's fine.

(Because, he isn't fine, he's never been fine, but right now, he's the most _not-fine_ he's ever been in his life, worse than that time his dad beat him five seconds away from death, worse than that time it was reversed, worse than any other time in his life.

Because, sometimes there are fires erupting from his wrists, and he's reminded of the sweet coolness of a razor blade against soft skin, he's reminded of the delicious way it feels to butcher himself, he's reminded of terrible things he's done, to others and to himself.)

He's got a reputation to uphold, though. A reputation he must keep up.

"Alex, you okay?" Meredith has awoken, and she stretches from her curled up position on the couch to the left of the bed. She yawns hugely while saying, "what time is it?"

He shrugs. "I dunno. Late, I guess. Or early. Whatever."

She nods, her hair a crazy mess, looking absolutely exhausted despite the how many hours of sleep she'd just had. He supposes he looks pretty similar, if not worse, but he's been rocking the 'emaciated skeleton-man who's just spent the last fifty-eight years in hell' look for enough time, it's become the default.

"You should go to your room, Mere. Get some actual sleep." Alex shifts positions, an ache building in the small of his back.

She nods and yawns again. "Yeah, I think I will. But… Not right now. Let's talk." Meredith leans forward, elbows propped on her knees, chin in her hands. She looks like a little kid, her blue eyes so big and earnest and just dripping with compassion. How can he not say anything?

"What do you want me to say?"

"You've been so distant lately. Which, you know, I totally understand why you would be. Having cancer and needing help on some occasions tends to violate the Alex Karev code, right? Need to keep up that" - and here she does lazy air quotes with her fingers - " _tough guy persona_. But, you'd be surprised how helpful it is to talk about it. I should know."

He rolls his eyes. "Wow. Never expected I'd get _this_ conversation from dark and twisty girl, over here. Do you want to compare bra sizes while we're at it?"

"Bra sizes?" Meredith wrinkles her nose. "Where'd you get that?"

He shrugs. "I dunno, don't girls do that at sleepovers?"

She let out a hearty laugh, and after some consideration, he joined in with an echoing chuckle. "I can assure you, that does _not_ happen. You've been watching too much… _Gossip Girl_ , or something."

Alex chews on the inside of his lip. "There's nothing to talk about. I'm fine, okay? I know all of you guys think that I'm depressed, or whatever, but give me a break! I have cancer. I'm pretty grumpy in general. I'm fine."

Meredith purses her lips, but nods after a few seconds. "Okay. If that's what you think. I'm going to bed now, okay? Sleep well." She stands up, yawns, and trudges outside.

There's an emptiness in his chest when she leaves.

Alex struggles to get out of bed the next day. Of course, he pretty much struggles to get out of bed everyday, but there's a heaviness in his entire body that he's sure wasn't there the day before. Physically, and mentally. Maybe he's going crazy. Or maybe he's just dying.

He has an appointment with Dr. Swender this morning. More of 'discussing his treatment options'. Everyone knows nothing is working. He's a dead man walking.

Or, as he struggles to make it down the stairs and has to sit on the step to catch his breath… A dead man barely walking. A dead man.

Derek, who seems to have moved into the house, sees him. "Whoa, Alex, are you alright?"

"Fine," he grumbles, shoving away the hand trying to help him. "Just taking a break."

He nods, and says, "Meredith is cooking breakfast." Alex makes a face, and Derek laughs. "Let me rephrase that. Meredith and _Izzie_ are cooking."

A pause. "Here, let me help you up." He frowns, but takes the hand anyway.

Things have changed.

/

Izzie drives him to the hospital. Everyone else has already gone, but it seems that she's worked something out with the Chief. Because, he can't drive himself, now. There's a lot he can't do by himself.

And, they don't let dead men drive.

"Alex, I'm sorry," she whispers. Her voice is thick with regret and sorrow and apology. And pity.

His cheek is pressed against the cool glass window, and he turns towards her. He's still angry. But he's also still tired. So he says, "It's okay, Iz."

She smiles gratefully. "It's really not, though. I should've talked to you about it. I shouldn't have called her. I'm just really sorry."

"Why'd you do it?"

"I… it's because I love you, Alex. You're one of my best friends. And you're so unhappy. I just want you to be happy. I thought that your sister would give you that. I shouldn't have assumed anything." They've reached the hospital. He pushes open the door, pulls the beanie lower, over his eyebrows. (If he still had eyebrows.)

They're nearly at the entrance when he says, "I'm sorry, too."

Alex isn't looking at her, but she's smiling. He knows it.

/

It's so strange, being in the hospital again. And awkward. Izzie leads him to the oncology department, then leaves him with a gentle squeeze of his hand and a soft smile. He misses her.

Alex makes his way to Dr. Swender's office, his head down the entire time. He pushes open the door. Immediately, something is wrong. Something is terribly wrong.

It's Dr. Swender, yes, but it's also Chief Webber and Dr. Bailey. All standing there, staring at him like the fucking Inquisition.

"Hell, no," he says and turns to leave.

But Bailey can move like lightning if she wants to, and she grabs his arm and plops him down on the chair before he can find a way to escape. "Sit down, Karev. We have things to discuss."

"What the hell?" he explodes. "What is this?"

"Alex," Dr. Swender says calmly, "It has come to my attention that you've been exhibiting signs of depression."

"Jesus Christ. I'm done, alright? I'm freaking fine. I don't need this." He moves to get out of the chair, but Bailey shoots him an icy glare and a threatening _Karev…_ It's enough to chill his blood. He sits back down.

"I know you might not think that your mental health has anything to do with your physical well being. But the unfortunate truth is that, at times, I've seen the strongest of patients lose their life because of their mental state."

Alex grinds his teeth. Takes a deep breath. Tries not to scream. "So - what. Are you saying I could be cancer-free now, if I'd just kept a positive attitude? Is that what you're saying?"

Bailey sighs, steps forward a little. "Depression is more than an 'attitude', Alex. That's not what we're saying. We're saying that this is a really terrible time for you. It's difficult. We understand. It's perfectly normal to be depressed under these circumstances. We want to help you. _I_ want to help you."

He stares at her. A second. A minute. An hour. Forever? He's just so tired.

He's just so tired, now. He's always been tired. He was born tired.

She's staring at him now. Crying. A tear slips, unbidden from her eye, and Alex is shocked to find that his cheeks are wet. "What do you mean, Alex?" Bailey ask him, her voice torn and beaten. "What do you mean, you were 'born sad'?"

"I'm always tired, Dr. Bailey. I've never not been tired. I was born tired. I was born sad. It's not just this. No amount of treatment will cure me. You don't have to waste your time." There's an immediate sense of relief that washes over him the moment the words wash out of his mouth. And then, doom. What the hell has he done? Saying poetic shit like this? They're not idiots. They'll know. They'll see the scars.

He isn't aware of the thunderous pounding of his heart and the sweat pooling in his palms and the tightness in his throat as he struggles to fucking breathe and suddenly, there are a lot of loud noises and screaming and ' _someone get him oxygen!_ ' and he's sliding onto the floor, his heaving gasps stuffing the air with noise, he's done for he's over he's dying he's dying he's dying he's dying he's dying he's dead.

He's dead.

Good.


End file.
